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PRINTER'S NO. 463
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
18
Session of
2017
INTRODUCED BY MACKENZIE, A. HARRIS, HEFFLEY, MILLARD, SIMMONS
AND TOPPER, FEBRUARY 13, 2017
REFERRED TO COMMITTEE ON LABOR AND INDUSTRY, FEBRUARY 13, 2017
AN ACT
Amending the act of June 2, 1915 (P.L.736, No.338), entitled, as
reenacted and amended, "An act defining the liability of an
employer to pay damages for injuries received by an employe
in the course of employment; establishing an elective
schedule of compensation; providing procedure for the
determination of liability and compensation thereunder; and
prescribing penalties," in liability and compensation,
further providing for prescription drugs and the treatment of
work-related injuries; and, in procedure, further providing
for peer review.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 306(f.1)(3)(vi) of the act of June 2, 1915
(P.L.736, No.338), known as the Workers' Compensation Act, is
amended by adding a provision and paragraph (6) is amended by
adding a subclause to read:
Section 306. The following schedule of compensation is
hereby established:
* * *
(f.1) * * *
(3) * * *
(vi) * * *
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(J) The department shall select a nationally recognized,
evidence-based prescription drug formulary appropriate for
resolving issues related to drugs prescribed for or related to
the treatment of work-related injuries, including, but not
limited to, the type, dosage and duration of prescriptions. The
following shall apply:
(I) Within thirty (30) days of the effective date of this
provision, the department shall solicit public comments
regarding the selection of a prescription drug formulary under
this provision. The public comment period shall be at least
thirty (30) days but not more than ninety (90) days. The
department shall publish notice of the public comment period in
the Pennsylvania Bulletin.
(II) Within thirty (30) days after close of the public
comment period under subprovision (I), the department shall
publish notice of its selection of a prescription drug formulary
in the Pennsylvania Bulletin. The prescription drug formulary
shall take effect thirty (30) days after the publication
required by this subprovision.
(III) The department shall ensure that the current
prescription drug formulary is available through its publicly
accessible Internet website for reference by physicians and the
general public.
(IV) The prescription of drugs that is not consistent with
or recommended by the prescription drug formulary selected by
the department shall not be considered reasonable and necessary
for the purposes of paragraph (6).
* * *
(6) Except in those cases in which a workers' compensation
judge asks for an opinion from peer review under section 420,
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disputes as to reasonableness or necessity of treatment by a
health care provider shall be resolved in accordance with the
following provisions:
* * *
(v) The department shall approve only those utilization
review organizations that it determines have obtained
certification as a utilization review entity under section 2151
of the Insurance Company Law of 1921.
* * *
Section 2. Section 420 of the act is amended to read:
Section 420. (a) The board, the department or a workers'
compensation judge, if it or he deem it necessary, may, of its
or his own motion, either before, during, or after any hearing,
make or cause to be made an investigation of the facts set forth
in the petition or answer or facts pertinent in any injury under
this act. The board, department or workers' compensation judge
may appoint one or more impartial physicians or surgeons to
examine the injuries of the plaintiff and report thereon, or may
employ the services of such other experts as shall appear
necessary to ascertain the facts. The workers' compensation
judge when necessary or appropriate or upon request of a party
in order to rule on requests for review filed under section
306(f.1), or under other provisions of this act, may ask for an
opinion from peer review about the reasonableness or necessity
[or frequency] of treatment under section 306(f.1). The peer
review report or the peer report of any physician, surgeon, or
expert appointed by the department or by a workers' compensation
judge, including the report of a peer review organization, shall
be filed with the board or workers' compensation judge, as the
case may be, and shall be a part of the record and open to
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inspection as such. The workers' compensation judge shall
consider the report as evidence but shall not be bound by such
report.
(b) The board or workers' compensation judge, as the case
may be, shall fix the compensation of such physicians, surgeons,
and experts, and other peer review organizations which, when so
fixed, shall be paid out of the Workmen's Compensation
Administration Fund.
(c) Peer review performed under this section and peer review
organizations used under this section shall comply with the
requirements established under section 306(f.1)(6).
Section 3. This act shall take effect in 60 days.
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